Utility 1911 Truck Check

• Conducted on

  Date

• Document No.

Crew Cab Inspection

• Mileage

• Engine Hours

• Fuel Level

  FULL

  3/4

  1/2

  1/4

  N/A

• DEF Fluid Level

  FULL

  3/4

  1/2

  1/4

  N/A

• Volts

  8

  10

  12

  14

  16

• Oil PSI

  Select 10 20 30 40 50 60 70 80

  • 10
  • 20
  • 30
  • 40
  • 50
  • 60
  • 70
  • 80

• Water Temp

  Select 100 150 160 170 180 190 200 210 220 230 240 250

  • 100
  • 150
  • 160
  • 170
  • 180
  • 190
  • 200
  • 210
  • 220
  • 230
  • 240
  • 250

• Trans Oil Temp

  90

  150

  200

  300

  400

• Front Air

  Select 70 80 90 100 110 120 130

  • 70
  • 80
  • 90
  • 100
  • 110
  • 120
  • 130

• Whelen Siren

  Operational

  May Require Attention

  Out Of Service

• Windshield Wipers

  Operational

  May Require Attention

  Out Of Service

• All Switches Fucntional

  Operational

  May Require Attention

  Out Of Service

• Mobile Radio set to Dispatch 1

  Operational

  May Require Attention

  Out Of Service

• FM Radio

  Operational

  May Require Attention

  Out Of Service

• All Seat Belts and Latches Checked for Wear and Tear

  Operational

  May Require Attention

  Out Of Service

Engine Inspection

• Power Steering- Full

  Operational

  May Require Attention

  Out Of Service

• Engine Oil- Full

  Operational

  May Require Attention

  Out Of Service

• Hoses

  Operational

  May Require Attention

  Out Of Service

• Belts

  Operational

  May Require Attention

  Out Of Service

• Coolant- full @ sight gauge

  Operational

  May Require Attention

  Out Of Service

• Oil Leaks Present

  Operational

  May Require Attention

  Out Of Service

Battery Inspection

• Terminals tight & clean

  Operational

  May Require Attention

  Out Of Service

Exterior Inspection

• Head Lights - Low

  Operational

  May Require Attention

  Out Of Service

• Head Lights - High

  Operational

  May Require Attention

  Out Of Service

• Right and Left turn signals w/ Side scene activation

  Operational

  May Require Attention

  Out Of Service

• Parking Lights

  Operational

  May Require Attention

  Out Of Service

• Back Up Lights

  Operational

  May Require Attention

  Out Of Service

• All Warning Lights

  Operational

  May Require Attention

  Out Of Service

• Compartment Doors

  Operational

  May Require Attention

  Out Of Service

• Compartment Lights

  Present and Operating

  Deficient

• Check Lifepak 12

  Present and Operating

  Deficient

• Check all Medical Equipment

  Operational

  May Require Attention

  Out Of Service

• Walk around check to notice any body damage and look for any noticeable problems

Tire Inspection

• Front Pressure (PSI)

• Rear Pressure (PSI)

• Uneven Wear

  No

  Yes

• Visible Defects

  No

  Yes

• Wheel Chocks (2)

  Operational

  May Require Attention

  Out Of Service

Chassis Inspection

• Any Leaks

  Operational

  May Require Attention

  Out Of Service

• Wires Loose or Hanging

  No

  Yes

Additional Information

• Engineer Comments

• List of Recommended Repairs needed from Monthly Inspection

Repairs

• Any repairs/action needed?

  Yes

  No

• Repairs Completed By

  Engineer

  Keystone

  Glick

• Completed By

  Dave Snyder

  John Yester

  Andrew Koleck

• Completed

  Date

• Repairs accepted by Engineer

  Dave Snyder

  John Yester

  Andrew Koleck

• Select date

  Date

• Add signature

  Sign

• Select date

  Date

• Signature Required

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